Vacuum Extraction

*shiver*

Even the name is rather unpleasant, isn't it?

In my line of work, it's far more likely for me to run into a negative outcome related to the use of vacuums in the delivery room, rather than the (so I've been told) many times when this method has been used without problems.

Despite knowing this, however, I still can't help but frown when I hear or read about the vac-assist during report or chart review. Gut reaction, I suppose, stemming from the relatively few negative outcomes I've witnessed.

One in particular stands out, because it was one of the first times that I remember feeling both pride in my skills and fear of what I don't know at the same time.

One patient of mine had the unfortunate experience of receiving multiple failed vacuum attempts during an attempted vaginal delivery, which ended in a c-section (and the thought of having to push the baby back up to be delivered... *shudder*). In the note from the other hospital, the word "multiple" was underlined twice. Once delivered, it was clear that all was not well. Extremely boggy head, baby difficult to arouse at times, and clearly in pain when she was awake. Every movement and attempt at repositioning her resulted in a sad grimace and heart-wrenching squeaky whimper.

I've yet to feel a head quite like hers since. She had a suspected subgaleal hemorrhage. I was unable to find the picture that a coworker used to teach me a little bit about a subgaleal bleed, but here's what I was able to find with a very "quick and dirty" google image search (so I guess what I'm trying to say is: hey, it's google, take 'em with a grain of salt)

Image 1
Image 2

It was that shift that I first noticed a patient of mine having a seizure. Hardly willing to believe myself due to the subtle nature of the seizure (I was practically glowing in the dark I was so green), I asked another nurse to come have a look, and she confirmed my observation and asked one of the house staff to step in and assess. This was the pride - finally trusting my skills

Being a newly transported admission, I had a 1:1 ratio with this baby, and was able to watch her closely, so when she started to look "off" we got to take a trip for a CT scan in the middle of the night. This was the first baby I'd ever had to do any sort of transport on, even if it was only in-house. This was (one of) the fears - taking a baby with head trauma for a test alone (in the end I asked for and received help from an experienced nurse), in which the baby would have to be removed from monitors for the test and I couldn't be standing right nearby to assess her myself. This resulted in the discovery of a skull fracture.

There's no dramatic ending to this encounter. The baby's condition gradually improved, her pain decreased, and after a few days she was no longer exhibiting any clinical seizure activity. She eventually went home on medication and with f/u appointments to see how she progressed.

So, not a disastrous ending, necessarily, though I've never heard any sort of update from the family, but still enough to stick with me, and make me cringe slightly every time I see the "vac-assist" box checked off. I suppose everybody has their quirks.